, Question 1
A patient started on clozapine 6 weeks ago presents with fever, tachycardia,
and a diffuse erythematous rash. Which laboratory finding would most strongly
confirm the priority life-threatening complication?
A. Absolute neutrophil count 0.4 × 10^9/L
B. Serum clozapine level 350 ng/mL
C. Creatine kinase 900 U/L
D. Eosinophil count 0.6 × 10^9/L
Correct Answer: A - Absolute neutrophil count 0.4 × 10^9/L
RATIONALE
Fever, tachycardia, and rash after clozapine initiation suggest severe
neutropenia/agranulocytosis, confirmed by ANC <0.5 × 10^9/L;
clozapine must be held immediately. Elevated clozapine level is not
the defining criterion, CK elevation suggests NMS, and eosinophilia is
nonspecific.
Question 2
Which nursing action best reflects trauma-informed care when a patient with
PTSD becomes hyperaroused during a routine assessment?
A. Continue the assessment to maintain structure and consistency.
B. Offer the patient control over pacing and seating, and validate their
response.
C. Move the patient to a quiet room and complete the assessment there.
D. Administer a PRN benzodiazepine before resuming the interview.
Correct Answer: B - Offer the patient control over pacing and
seating, and validate their response.
Page 2
, RATIONALE
Trauma-informed care prioritizes safety, choice, collaboration, and
empowerment; offering control and validation prevents
retraumatization. Forcing completion, relocating without consent, or
sedating first undermines autonomy and can escalate distress.
Question 3
A patient on lithium carbonate reports 3 days of vomiting and diarrhea. Which
finding requires the most immediate intervention?
A. Lithium level 1.4 mEq/L with coarse hand tremor
B. Lithium level 0.9 mEq/L with mild thirst
C. Lithium level 1.1 mEq/L with fine tremor
D. Lithium level 1.6 mEq/L with ataxia and confusion
Correct Answer: D - Lithium level 1.6 mEq/L with ataxia and
confusion
RATIONALE
Level >1.5 mEq/L with neurologic signs (ataxia, confusion) indicates
moderate-to-severe lithium toxicity requiring urgent intervention,
often hemodialysis. The other values are within or near therapeutic
range (0.6-1.2 mEq/L) with expected or mild effects.
Question 4
Which statement by a patient taking fluoxetine for major depressive disorder
indicates the most urgent need for follow-up?
A. "I've had a dry mouth since starting this medication."
B. "I feel more energized and I've been thinking about ways to end my
life."
C. "I take it every morning with breakfast."
D. "My sleep is improving and I feel less sad."
Correct Answer: B - "I feel more energized and I've been
Page 3
, thinking about ways to end my life."
RATIONALE
Emerging energy with persistent suicidal ideation signals activation
and elevated suicide risk, a well-documented early SSRI phenomenon
requiring immediate safety assessment. Dry mouth is expected,
morning dosing is correct, and improved mood/sleep are therapeutic.
Question 5
A patient with anorexia nervosa restricting type has a BMI of 13.2 and refuses
to eat. Which nursing action best reflects current evidence-based refeeding
protocol?
A. Allow the patient to choose all foods to promote autonomy.
B. Initiate a low-calorie, slow-advancement feeding plan with electrolyte
monitoring for refeeding syndrome.
C. Implement immediate high-calorie total parenteral nutrition.
D. Withhold all nutrition until the patient accepts treatment.
Correct Answer: B - Initiate a low-calorie, slow-advancement
feeding plan with electrolyte monitoring for refeeding syndrome.
RATIONALE
Severe malnutrition requires cautious, gradual caloric advancement
with close monitoring of phosphate, potassium, and magnesium to
prevent refeeding syndrome. Unrestricted choice or immediate
high-calorie/TPN increases risk; withholding nutrition violates ethical
and medical care.
Question 6
Which finding in a patient prescribed haloperidol most specifically indicates
neuroleptic malignant syndrome rather than acute dystonia?
A. Oculogyric crisis and torticollis
B. Lead-pipe rigidity, fever 39.4°C, and creatine kinase 2,500 U/L
Page 4
A patient started on clozapine 6 weeks ago presents with fever, tachycardia,
and a diffuse erythematous rash. Which laboratory finding would most strongly
confirm the priority life-threatening complication?
A. Absolute neutrophil count 0.4 × 10^9/L
B. Serum clozapine level 350 ng/mL
C. Creatine kinase 900 U/L
D. Eosinophil count 0.6 × 10^9/L
Correct Answer: A - Absolute neutrophil count 0.4 × 10^9/L
RATIONALE
Fever, tachycardia, and rash after clozapine initiation suggest severe
neutropenia/agranulocytosis, confirmed by ANC <0.5 × 10^9/L;
clozapine must be held immediately. Elevated clozapine level is not
the defining criterion, CK elevation suggests NMS, and eosinophilia is
nonspecific.
Question 2
Which nursing action best reflects trauma-informed care when a patient with
PTSD becomes hyperaroused during a routine assessment?
A. Continue the assessment to maintain structure and consistency.
B. Offer the patient control over pacing and seating, and validate their
response.
C. Move the patient to a quiet room and complete the assessment there.
D. Administer a PRN benzodiazepine before resuming the interview.
Correct Answer: B - Offer the patient control over pacing and
seating, and validate their response.
Page 2
, RATIONALE
Trauma-informed care prioritizes safety, choice, collaboration, and
empowerment; offering control and validation prevents
retraumatization. Forcing completion, relocating without consent, or
sedating first undermines autonomy and can escalate distress.
Question 3
A patient on lithium carbonate reports 3 days of vomiting and diarrhea. Which
finding requires the most immediate intervention?
A. Lithium level 1.4 mEq/L with coarse hand tremor
B. Lithium level 0.9 mEq/L with mild thirst
C. Lithium level 1.1 mEq/L with fine tremor
D. Lithium level 1.6 mEq/L with ataxia and confusion
Correct Answer: D - Lithium level 1.6 mEq/L with ataxia and
confusion
RATIONALE
Level >1.5 mEq/L with neurologic signs (ataxia, confusion) indicates
moderate-to-severe lithium toxicity requiring urgent intervention,
often hemodialysis. The other values are within or near therapeutic
range (0.6-1.2 mEq/L) with expected or mild effects.
Question 4
Which statement by a patient taking fluoxetine for major depressive disorder
indicates the most urgent need for follow-up?
A. "I've had a dry mouth since starting this medication."
B. "I feel more energized and I've been thinking about ways to end my
life."
C. "I take it every morning with breakfast."
D. "My sleep is improving and I feel less sad."
Correct Answer: B - "I feel more energized and I've been
Page 3
, thinking about ways to end my life."
RATIONALE
Emerging energy with persistent suicidal ideation signals activation
and elevated suicide risk, a well-documented early SSRI phenomenon
requiring immediate safety assessment. Dry mouth is expected,
morning dosing is correct, and improved mood/sleep are therapeutic.
Question 5
A patient with anorexia nervosa restricting type has a BMI of 13.2 and refuses
to eat. Which nursing action best reflects current evidence-based refeeding
protocol?
A. Allow the patient to choose all foods to promote autonomy.
B. Initiate a low-calorie, slow-advancement feeding plan with electrolyte
monitoring for refeeding syndrome.
C. Implement immediate high-calorie total parenteral nutrition.
D. Withhold all nutrition until the patient accepts treatment.
Correct Answer: B - Initiate a low-calorie, slow-advancement
feeding plan with electrolyte monitoring for refeeding syndrome.
RATIONALE
Severe malnutrition requires cautious, gradual caloric advancement
with close monitoring of phosphate, potassium, and magnesium to
prevent refeeding syndrome. Unrestricted choice or immediate
high-calorie/TPN increases risk; withholding nutrition violates ethical
and medical care.
Question 6
Which finding in a patient prescribed haloperidol most specifically indicates
neuroleptic malignant syndrome rather than acute dystonia?
A. Oculogyric crisis and torticollis
B. Lead-pipe rigidity, fever 39.4°C, and creatine kinase 2,500 U/L
Page 4
